Santosh Kumar Selvarajan MD, Presenter: Nothing to Disclose

David C. Levin MD, Abstract Co-Author: Consultant, HealthHelp, LLC Board of Directors, Outpatient Imaging Affiliates, LLC

Vijay Madan Rao MD, Abstract Co-Author: Nothing to Disclose

Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

Previous studies have shown that the all imaging utilization rates have been stable since 2006 except CT which has continued to grow (overall annual growth of 3.4% from 2007-2009). From 2011, CPT codes for CT scans of the abdomen and pelvis were bundled into a single new code. Our purpose was to determine what effect this policy had on recent trends in CT utilization in ED.

The nationwide Medicare Part B databases for 2000-2012 were used. The codes for CT of the abdomen and CT of the pelvis were selected for all years of the study, and the bundled codes for CT abdomen/pelvis were selected for 2011 and 2012. Procedure volumes in ED and non-Ed (inpatient, office, and outpatient) settings were calculated. To understand the trends through the bundling years (2011 and 2012), we doubled the number of bundled codes, since these would have counted as 2 exams in 2010 and before.

The nationwide Medicare utilization rates of both CT abdomen and CT pelvis grew from 2000 to 2007 (4.8 M. to 9.7 M.) Thereafter, from 2008 to 2010, growth had stabilized except in ED (Non-ED, 8.1 M. to 7.7 M.; ED, 1.7 M. to 2.0 M). There is a dramatic drop off in 2011 due to bundling: non-ED, 7.7 M. 4.2 M., Ed, 2.0 to 1.2 M When the bundled exams are doubled, 2011 non-Ed is stable at 7.8 M. exams; ED increases substantially from 2010, to 2.3 M. exams. In 2012, again counting the bundled code as 2 exams, non-ED volume is stable, at 7.8 M., while ED volume again increases substantially, to 2.6 M.

Medicare volumes of CT of the abdomen and CT pelvis show an apparent decline, but this is an artifact of code bundling. While procedure volume is stable in non-ED settings, volume of CT of the abdomen and pelvis continue to grow strongly in the ED.

New guidelines are probably required to reduce the CT utilization rates in Emergency.

Selvarajan, S, Levin, D, Rao, V, Parker, L, ED CT of the Abdomen and Pelvis Utilization has Continued to Increase, Despite what Appears to be a Reduction in Procedures caused by Code Bundling.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045711.html